{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T10:29:31Z","timestamp":1787308171917,"version":"build-2736575974"},"reference-count":31,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T00:00:00Z","timestamp":1758240000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: Robot-assisted radical cystectomy (RARC) has demonstrated improved perioperative outcomes and recovery in bladder cancer (BCa) patients. This study compares patient and tumor characteristics, operative time (OT), length of stay (LOS), and complication rates between a historical (2003\u20132016) and a contemporary cohort (2017\u20132024) treated at a high-volume robotic center. Methods: Data from 274 BCa patients who underwent RARC at AZORG Hospital, Aalst, Belgium, were analyzed. Perioperative outcomes were compared between cohorts. Multivariable Poisson regression models identified predictors of longer OT and LOS, while multivariable logistic regression models (MLRMs) assessed predictors of higher complication rates. Results: Overall, 274 BCa patients who underwent RARC were identified (38% historical cohort vs. 62% contemporary cohort). The contemporary cohort had a significantly shorter median OT (345 vs. 360 min; p = 0.048) and LOS (8 vs. 12 days; p &lt; 0.001) compared to the historical cohort. Postoperative complications were lower in the contemporary group, with more cases experiencing no complications (60% vs. 41%) and fewer grade 3\u20134 complications (10% vs. 27%; p &lt; 0.001). In multivariable Poisson regression, the contemporary cohort was an independent predictor of shorter OT (Incidence Rate Ratio [IRR]: 0.94, 95% [Confidence Interval] CI: 0.93\u20130.96; p = 0.04) and shorter LOS (IRR: 0.65, 95% CI: 0.60\u20130.69; p &lt; 0.001). In MLRMs predicting complications, the contemporary cohort was associated with lower risk (Odds Ratio: 0.42, 95% CI: 0.23\u20130.76; p = 0.005). Conclusions: RARC outcomes improved significantly over time, with reduced OT, LOS, and complication rates in the contemporary cohort, highlighting advancements in surgical techniques, perioperative care, and patient safety. These findings reinforce the role of RARC in optimizing BCa treatment.<\/jats:p>","DOI":"10.3390\/cancers17183060","type":"journal-article","created":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T08:11:01Z","timestamp":1758269461000},"page":"3060","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Evolution of Perioperative Outcomes in Robot-Assisted Radical Cystectomy over 20 Years of Experience in a High-Volume Tertiary Robotic Center"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5340-8569","authenticated-orcid":false,"given":"Simone","family":"Morra","sequence":"first","affiliation":[{"name":"Department of Urology, AZORG Hospital, 9300 Aalst, Belgium"},{"name":"ORSI Academy, 9090 Melle, Belgium"},{"name":"Department of Neurosciences, Reproductive Sciences and Odontostomatology, School of Medicine, University of Naples \u201cFederico II\u201d, 80131Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8112-0877","authenticated-orcid":false,"given":"Stefano","family":"Resca","sequence":"additional","affiliation":[{"name":"Department of Urology, AZORG Hospital, 9300 Aalst, Belgium"},{"name":"ORSI Academy, 9090 Melle, Belgium"},{"name":"Department of Urology, University of Modena and Reggio Emilia, 41121 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Frego","sequence":"additional","affiliation":[{"name":"Department of Urology, AZORG Hospital, 9300 Aalst, Belgium"},{"name":"ORSI Academy, 9090 Melle, Belgium"},{"name":"Department of Urology, Humanitas Research Hospital, IRCCS, 20089 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6695-8084","authenticated-orcid":false,"given":"Sara","family":"Tamburini","sequence":"additional","affiliation":[{"name":"Department of Urology, AZORG Hospital, 9300 Aalst, Belgium"},{"name":"ORSI Academy, 9090 Melle, Belgium"},{"name":"Division of Urology, IRCCS Azienda Ospedaliero, Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9295-7456","authenticated-orcid":false,"given":"Marco","family":"Ticonosco","sequence":"additional","affiliation":[{"name":"Department of Urology, AZORG Hospital, 9300 Aalst, Belgium"},{"name":"ORSI Academy, 9090 Melle, Belgium"},{"name":"Department of Urology, University of Modena and Reggio Emilia, 41121 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2228-358X","authenticated-orcid":false,"given":"Alessandro","family":"Pissavini","sequence":"additional","affiliation":[{"name":"Department of Urology, AZORG Hospital, 9300 Aalst, Belgium"},{"name":"ORSI Academy, 9090 Melle, Belgium"},{"name":"Division of Urology, IRCCS Azienda Ospedaliero, Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0829-0003","authenticated-orcid":false,"given":"Andrea Noya","family":"Mourullo","sequence":"additional","affiliation":[{"name":"Department of Urology, AZORG Hospital, 9300 Aalst, Belgium"},{"name":"ORSI Academy, 9090 Melle, Belgium"},{"name":"Urology Department, University Hospital of Salamanca, 37007 Salamanca, Spain"},{"name":"UROINTEC Urologia, Innovaci\u00f3n, Tecnolog\u00eda, 35001 Las Palmas de Gran Canaria, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Barletta","sequence":"additional","affiliation":[{"name":"Department of Urology, AZORG Hospital, 9300 Aalst, Belgium"},{"name":"ORSI Academy, 9090 Melle, Belgium"},{"name":"Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0494-7839","authenticated-orcid":false,"given":"Mario","family":"de Angelis","sequence":"additional","affiliation":[{"name":"Department of Urology, AZORG Hospital, 9300 Aalst, Belgium"},{"name":"ORSI Academy, 9090 Melle, Belgium"},{"name":"Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward","family":"Lambert","sequence":"additional","affiliation":[{"name":"Department of Urology, AZORG Hospital, 9300 Aalst, Belgium"},{"name":"ORSI Academy, 9090 Melle, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederiek","family":"D\u2019Hondt","sequence":"additional","affiliation":[{"name":"Department of Urology, AZORG Hospital, 9300 Aalst, Belgium"},{"name":"ORSI Academy, 9090 Melle, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruben","family":"De Groote","sequence":"additional","affiliation":[{"name":"Department of Urology, AZORG Hospital, 9300 Aalst, Belgium"},{"name":"ORSI Academy, 9090 Melle, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geert","family":"De Naeyer","sequence":"additional","affiliation":[{"name":"Department of Urology, AZORG Hospital, 9300 Aalst, Belgium"},{"name":"ORSI Academy, 9090 Melle, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre","family":"Mottrie","sequence":"additional","affiliation":[{"name":"Department of Urology, AZORG Hospital, 9300 Aalst, Belgium"},{"name":"ORSI Academy, 9090 Melle, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.eururo.2020.03.055","article-title":"European Association of Urology Guidelines on Muscle-Invasive and Metastatic Bladder Cancer: Summary of the 2020 Guidelines","volume":"79","author":"Witjes","year":"2021","journal-title":"Eur. 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